23D2002335 CLIA NUMBER - RESIDENTIAL HOSPICE

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Laboratory Demographics

CLIA Number: 23D2002335

Facility Name: RESIDENTIAL HOSPICE

Facility Address:
5440 CORPORATE DRIVE SUITE 400
TROY, MI
ZIP 48098
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Facility Phone Number: 866 902-5854

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1891164554

Taxonomy: 363LA2200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	23D2002335
LAB Type	Home Health Agency
Facility Name	RESIDENTIAL HOSPICE
Street	5440 CORPORATE DRIVE SUITE 400
City	TROY
State	MI
ZIP	48098
Phone	866 902-5854
CertificateType	4
CertificateEffectiveDate	1/13/2024
CertificateExpirationDate	1/12/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024